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Professional
Liability Program
Emory
Liability Program Questions & Answers As
an Emory employee or student, you are insured for professional and general
liability exposures for activities falling within the course and scope of
your employment or training within the Emory system. Professional
liability insurance protects you in the event a claim is asserted against
you in connection with your "professional" responsibilities as a
physician, nurse, resident, teacher, lawyer, etc. General liability
insurance protects you in the event a claim is asserted against you in
connection with non-professional responsibilities, such as the obligation
to maintain a safe campus environment or the duty to live up to the terms
of a contract. This
document provides you with information about your liability insurance
coverage as an employee or student at Emory. Q.
WHAT IS EMORY'S LIABILITY INSURANCE PROGRAM? A.
The Emory system is insured for professional and general liability
exposures under a comprehensive multi-layered program in which the system
retains a portion of risk through a captive insurance company subsidiary
and transfers the remaining risk to the commercial market.
A
captive insurance company is a company formed to insure the risks of its
parent. Clifton Casualty Insurance Company Ltd. ("CCIC") retains the
primary limit of $3,000,000 per claim for professional liability and
$1,000,000 per claim for general liability. Additional limits are
purchased in excess of the primary layer and the amount of excess
insurance is determined annually. Q.
DOES THE PROFESSIONAL LIABILITY INSURANCE PROVIDED TO ME BY EMORY COVER
ALL OF MY PROFESSIONAL SERVICES? A.
If you are employed at Emory, you are insured for activities falling
within the course and scope of your employment within the system. In
some instances, your insurance may be extended to include acts at a
non-Emory facility if the compensation for that service is received by
Emory, the activity is undertaken at the direction of your Section or
Program Head, and it has been approved by the Chief Executive Officer of
your institution. Q.
IF I LEAVE EMORY, WILL I BE COVERED FOR CLAIMS ARISING OUT OF ACTIVITIES
IN WHICH I PARTICIPATED WHILE I WAS STILL EMPLOYED OR TRAINING WITHIN THE
EMORY SYSTEM? A.
The Emory insurance program is written on a "claims-made"
basis but it has been modified to cover claims and suits arising from
events which occurred while you were with Emory even if the claim or suit
is brought after you leave the system. At the present time, you do
not need to purchase "tail" coverage when you leave Emory, no matter what
reason you have for leaving.
Q.
WHO
IS ON THE BOARD OF THE CAPTIVE? A.
The CCIC Board is composed of members of the Emory Board of Trustees and
senior management, faculty and medical staffs of
Emory. Q.
MANY
INSURANCE COMPANIES SETTLE MOST CASES FOR ECONOMIC REASONS REGARDLESS OF
MERIT OR LACK OF MERIT. IS THIS EMORY'S
PHILOSOPHY? A.
No. Emory's philosophy is to carefully evaluate each case on its own
merits. If there is clear liability on the part of the insured,
settlement in a reasonable amount related to the nature and extent of
injury will be pursued. If liability is unclear, discovery will be
undertaken to gather whatever information is necessary to make a
settlement decision. Cases lacking merit will be vigorously
defended. Q.
WHAT DO I DO IF A CLAIM IS MADE AGAINST ME OR I AM SERVED WITH
LAWSUIT? A.
If you receive notice of a claim or a lawsuit, you should immediately
contact the Office of Risk & Insurance Services. Staff will meet
with you to go over the circumstances surrounding the matter in which you
have been noticed. Individuals from claims and risk management will
familiarize you with the claims management process to help you deal with
the anxiety and stress that are natural and inevitable reactions to being
sued. Q.
WILL I HAVE INPUT INTO THE SETTLEMENT OF CLAIMS OR SUITS IN WHICH I AM
INVOLVED? A.
Yes. Whenever a claim or suit in which you are involved is evaluated
for settlement, your opinion and input will be requested. Your thoughts
are valuable in assessing the strengths and weaknesses of the case in
order to make a settlement decision. Q.
I
HAVE SEEN INSURANCE POLICIES THAT REQUIRE THE POLICYHOLDER, OR INSURED, TO
"COOPERATE" WITH THE COMPANY. DOES THE EMORY PROGRAM HAVE THIS SAME
REQUIREMENT AND, IF SO, WHAT DOES IT MEAN? A.
Yes. The Emory Program requires that its insureds cooperate and assist in the investigation,
evaluation, and assessment of all cases. Your assistance in
gathering information is critical in helping to assure that all facts
pertinent to the case can be discovered. You are also required to
cooperate with outside counsel, when assigned, and Emory's claims
management staff in order to prepare a defense. Q.
HOW DOES EMORY ASSESS THE MERITS OF A CASE AND DEVELOP ITS
STRATEGY?
A.
When a claim is asserted or a lawsuit is filed, the Office of Risk &
Insurance Services will review the care provided to identify any possible
breaches in the applicable standard of care. Emory physicians, with
expertise in the relevant areas, may be asked to review the clinical
aspects of the case. Most often this individual will be a Section
Head in the relevant specialty. Expert reviewers not affiliated with
Emory may also review the case and provide a formal opinion if the case
proceeds to litigation. On
a monthly basis, cases are presented to the Emory Healthcare Clinical
Claims Review Working Group to obtain advice on the merits of individual
cases, to develop defense strategies, and to obtain settlement authority
when necessary. Strategy is further developed through consultation with
the involved physician and defense counsel. Strategy will, of
course, differ from case to case depending on the circumstances of each
individual case. Q.
HOW
ARE DEFENSE COUNSEL SELECTED AND ASSIGNED TO
CASES? A.
Reputable defense counsel with expertise in professional liability actions
are identified and interviewed to determine the philosophy of the firm,
degree of expertise, staffing, fees, and willingness to adhere to Emory
expectations in terms of timeliness, preparation, and approach to
litigation. Qualified defense firms, willing to commit to Emory's
standards, are recommended to the Emory Healthcare Clinical Claims Review
Working Group for final approval. Adherence to established
guidelines and expectations is closely monitored. Counsel that fails
to meet these requirements will be dropped from the approved
list. When
individual cases are assigned to defense counsel, the particular counsel's
expertise, the facts of the case and "fit" with the defendants are all
considered. Every attempt is made to assure that defendants are
comfortable with assigned counsel. Q.
WILL
I AUTOMATICALLY RECEIVE EVIDENCE OF INSURANCE? A.
No. If you require evidence of insurance, please contact the Office
of Risk & Insurance Services at (404)
778-7937. If
you have any further questions or require additional information, please
contact: Cheryl
Ritchie,
Director Laura
Deane, Director |
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